Relationship of different levels of physical activity on the health status of long-term breast cancer survivors: a cross-sectional study

The first objective of this study is to examine the relationship between different levels of physical activity (PA) and the health status of long-term breast cancer survivors (LTBCSs) who have survived ≥5 years beyond diagnosis. The second aim is to identify potential predictors of long-term PA levels in this population. An 80-participant cross-sectional study categorized LTBCSs by PA levels: insufficiently active (very low ≤3 metabolic equivalent task (MET), low 3.1–7.4 MET) and sufficiently active (≥7.5 MET). Variables assessed included PA, pain, self-perceived physical fitness, cancer-related fatigue (CRF), comorbidities, mood, and health-related quality of life (HRQoL). ANOVA, Mann-Whitney U, and Chi-square tests were performed, along with Spearman’s correlation and multiple regression analysis. Cohen’s <i>d</i> and Cramér’s <i>V</i> were used to calculate effect sizes. 66.25% of LTBCSs were insufficiently active, with 17.25% classified as sedentary (≤1.5 MET). In the first objective, and compared to sufficiently active survivors, insufficiently active LTBCSs reported higher levels of pain, breast symptoms, dyspnea, moderate-to-severe CRF, sadness/depression, and anger, along with lower levels of happiness, general fitness, speed/agility, role functioning, and HRQoL (<i>p</i> &lt; 0.05). In the second objective, the regression analysis found "future perspective" (β = 0.314; <i>p</i> &lt; 0.01) and "insomnia" (β = −0.288; <i>p</i> = 0.02) to be significant predictors of higher PA levels (r² = 0.224). Insufficiently active LTBCSs had higher pain, symptoms, CRF, and mood disturbances, with decreased happiness, self-perceived physical fitness, and HRQoL. Future research should focus on interventions that target improving PA levels and managing factors such as "future perspective" and "insomnia," as they are significant predictors of PA adherence. These findings underscore the importance of incorporating PA into rehabilitation programs to enhance overall well-being and HRQoL in LTBCSs. Here are presented the bullet points that highlight the implications for rehabilitation of this study:The majority of long-term breast cancer survivors (≥5 years post-diagnosis) do not meet recommended physical activity guidelines (66.25%). This inactivity is significantly correlated with greater physical and emotional deterioration.Emphasizing adherence to physical activity before, during, and after breast cancer treatment is crucial. Patients should understand that physical activity is not merely a "lifestyle recommendation" but a biological necessity.Developing strategies to promote long-term adherence to physical activity should be a primary focus for future research and rehabilitation programs.Future research should focus on identifying and addressing barriers to physical activity adherence in long-term breast cancer survivors. The majority of long-term breast cancer survivors (≥5 years post-diagnosis) do not meet recommended physical activity guidelines (66.25%). This inactivity is significantly correlated with greater physical and emotional deterioration. Emphasizing adherence to physical activity before, during, and after breast cancer treatment is crucial. Patients should understand that physical activity is not merely a "lifestyle recommendation" but a biological necessity. Developing strategies to promote long-term adherence to physical activity should be a primary focus for future research and rehabilitation programs. Future research should focus on identifying and addressing barriers to physical activity adherence in long-term breast cancer survivors.

本研究首要目标旨在探讨不同水平身体活动（PA）与诊断后存活≥5年的长期乳腺癌幸存者（LTBCSs）健康状况之间的关系；次要目标为确定该人群中长期PA水平的潜在预测因子。本研究纳入80名受试者开展横断面研究，将LTBCSs按PA水平归类为：活动不足组（极低≤3代谢当量任务（MET）、低3.1–7.4 MET）与活动充分组（≥7.5 MET）。评估变量包括PA、疼痛、自我感知体能、癌症相关疲劳（CRF）、合并症、情绪及健康相关生活质量（HRQoL）。研究采用方差分析（ANOVA）、Mann-Whitney U检验、卡方检验，以及Spearman相关分析和多元回归分析；效应量计算则运用Cohen's d与Cramér’s V。

66.25%的LTBCSs活动不足，其中17.25%为久坐状态（≤1.5 MET）。针对首要目标的分析显示，与活动充分的幸存者相比，活动不足的LTBCSs报告更高水平的疼痛、乳房症状、呼吸困难、中重度CRF、悲伤/抑郁及愤怒，同时幸福感、整体体能、速度/敏捷性、角色功能及HRQoL水平更低（p < 0.05）。

针对次要目标的回归分析表明，“未来展望”（β=0.314；p < 0.01）与“失眠”（β=-0.288；p=0.02）是更高PA水平的显著预测因子（r²=0.224）。

活动不足的LTBCSs存在更高程度的疼痛、症状、CRF及情绪障碍，同时幸福感、自我感知体能及HRQoL均降低。未来研究应聚焦于旨在提升PA水平及管理“未来展望”与“失眠”等因素的干预措施，因其为PA依从性的显著预测因子。这些发现强调了将PA纳入康复方案以提升LTBCSs整体福祉及HRQoL的重要性。

本研究对康复的启示要点如下：
- 大多数长期乳腺癌幸存者（诊断后≥5年）未达到推荐的身体活动指南标准（66.25%），这种活动不足与更严重的身心恶化显著相关。
- 强调乳腺癌治疗前、中、后的身体活动依从性至关重要，患者应认识到身体活动并非单纯的“生活方式建议”，而是生物学必需。
- 制定促进长期身体活动依从性的策略应成为未来研究及康复方案的核心重点。
- 未来研究应聚焦于识别并解决长期乳腺癌幸存者身体活动依从性的障碍。
- 大多数长期乳腺癌幸存者（诊断后≥5年）未达到推荐的身体活动指南标准（66.25%），这种活动不足与更严重的身心恶化显著相关。
- 强调乳腺癌治疗前、中、后的身体活动依从性至关重要，患者应认识到身体活动并非单纯的“生活方式建议”，而是生物学必需。
- 制定促进长期身体活动依从性的策略应成为未来研究及康复方案的核心重点。
- 未来研究应聚焦于识别并解决长期乳腺癌幸存者身体活动依从性的障碍。